TUMOURS AND TUMOROUS CONDITIONS OF THE HAND

Prepared by:Dr.mohamed Abd alhussein LaftahBAGHDAD UNIVERSITYALKINDY COLLEGE OF MEDICINEAlwasity teaching hospital

Hand tumors arise from any tissue—skin, subcutaneous tissue,tendons, nerve, blood vessels, and bone.

Hand tumour can be classified in many different ways which may cause confusion between types and their management plan.

This lecture mainly concerned about how to classify them in simple and accurate way.

Benign tumors account for 95% of hand masses if skin cancers are excluded.

Ganglions represent 60 to 70% of hand tumors, followed in frequency by inclusion cysts, warts, (verruca vulgaris),giant cell tumors of tendon sheaths, foreign body granulomas,lipomas and hemangiomas.

Hand tumour can be classified into major 3 type:

1. Benign tumors.2. Malignant tumors .3. Tumorous conditions .

Each of benign and malignant type can further be classified according to tissue of origin into:

1. Bone tumour.2. Soft tissue tumour.3. Skin tumour.

Benign tumours1. Bone tumours:Enchondromas OsteochondromasOsteoid oseoma.Benign osteoblastoma Aneurysmal bone cyst Giant cell tumors of bone Synovial chondromatosis .OsteophyteChondromixoidfibroma

Enchondromthe most common primary hand bone tumor,occurs chiefly in the 3rd and 4th decades It occurs most commonly in the phalanges, usually in the proximal phalanx

Osteochondroma

consists of a bony prominence at the level of the metaphysis covered by a cartilaginous cap.

Osteoid osteoma is an unusual hand tumor occur in phalanges, metacarpals,and carpal bones, and presents in the 2nd and 3rd decades of life with aching pain that is greatest at night. classically relieved by aspirin

Giant cell tumors of bone

Aneurysmal bone cyst

Synovial chondromatosis .

Osteophyte

Chondromixoid fibroma

2.Soft tissue tumours: Muscl : leiomyoma. Tendon: fibroma of tendon sheath.Giant cell tumor of tendon sheath

(xanthoma of the tendon Sheath).Xanthoma Tuberosum

leiomyoma

fibroma of tendon sheath

Giant cell tumor of tendon sheath

Xanthoma Tuberosum

Fibrous tumour:FibromaDermato fibroma (fibrous

histiocytoma)Nodular fasciaitis.Firomatosis. Juvenile Aponeurotic Fibroma Infantile digital fibroma.

Juvenile Aponeurotic Fibroma

Fibroma

Dermato fibroma

Nodular fasciaitis

Firomatosis.

Infantile digital fibromatosis

Adipose tissue tumour:Lipoma.  Infiltrating lipomas. Lipoblastomas. Intraneural lipofibromas.

Lipoma

Tumors of Peripheral Nerves: Neurofibroma. Schwannoma. Granular Cell Tumor. Neurothekeoma (pacinian neurofibroma). INTRANEURAL TUMORS OF NONNEURAL

ORIGINNumerous nonneural tumors have been reported

in peripheral nerves: lipomas, lipofibromatous hamartomas, and hemangiomas.

Neurofibroma

Schwannoma

Granular Cell Tumor

Neurothekeoma median nerve

Vascular Tumors:Hemangioma . Vascular malformation .Lymphangioma .Post traumatic vascular lesion:Traumatic fistulasAtherosclerotic aneurysms.Pyogenic granuloma.Glomus Tumor

Hemangioma

Vascular malformation

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Lymphangioma

Pyogenic granuloma

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Glomus Tumor

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Skin

Benign tumour of skin can be classified according to structure of origin in the skin:

epidermal layer:verruca vulgaris(wart).Keratosis:seborrheac,actinic,solar,irra

diation.ProkeratosisCutaneous HornsKeratoacanthoma

verruca vulgaris(wart).

Keratosis:

Cutaneous Horns

Keratoacanthoma

Tumors of epidermal appendages Pilomatricoma(calcifying epithelioma

of Malherbe) Eccrine poroma . Eccrine Spiradenoma.

Eccrine poroma

Eccrine Spiradenoma

Pilomatricoma

fibrous dermis:Pigmented NeviBlue NeviDermatofibroma

Pigmented Nevi

Blue Nevi

Malignant hand tumours

Bone :Osteogenic Sarcoma.Chondrosarcoma.Ewing Sarcoma.Bone Tumors of the Hemopoietic

System e.g. Malignant lymphomasMetastatic lesion

Osteogenic Sarcoma

Chondrosarcoma.

Ewing Sarcoma

Metastatic lesion

Hand Soft tissue malignancy Its mainly sarcoma: Clear cell sarcoma Dermatofibrosarcoma protuberance. Extra abdominal desmoid. Epithelioid sarcoma. Fibrosarcoma. Kaposi sarcoma. Malignant fibrous histiocytoma. Rhabdomyosarcoma. Synovial sarcoma. Acralmyxoinflammatory sarcoma. Fibroblastic sarcoma. Myofibrosarcoma.Mlignant neural tissue: Neurosarcoma Malignant schwannoma.

Dermatofibrosarcoma protuberance.

Epithelioid sarcoma

Fibrosarcoma.

Skin malignancy

Basal cell carcinomaSquamous cell carcinoma.Malignant melanoma.Sweat gland carcinoma.

Sweat gland carcinoma

Tumorous conditions

Its usually not true tumour we can subdivide them to :

1. Cystic leision: Ganglion cyst. Epidermoid cyst (inclusion cyst) .  Sebaceous cyst

Ganglion cyst

DIP Ganglions

Epidermoid cyst (inclusion cyst)

Sebaceous cyst

2.Non cystic leision:Foreign body reaction.Gouty leisionCutaneous Horns Infection: Viral: e.g. wart Bacterial. Fungal.

Foreign body reaction.

The biggest hand in the world

Thank you